What are the recommendations for a colonoscopy?

From the Guidelines

Colonoscopy screening should begin at age 45 for average-risk individuals and continue until age 75, with screenings typically performed every 10 years, as recommended by the U.S. Multi-Society Task Force on Colorectal Cancer 1. The preparation for a colonoscopy typically involves a clear liquid diet the day before the procedure and consuming a bowel-cleansing solution such as GoLYTELY, MoviPrep, or SUPREP, usually split between the evening before and morning of the procedure.

• Patients should arrange transportation home as sedation prevents driving for 24 hours after the procedure.
• Medications like blood thinners, NSAIDs, and certain diabetes medications may need adjustment before the procedure—consult your doctor about specific medication instructions. The colonoscopy itself takes about 30-60 minutes, with recovery lasting 1-2 hours.
• This screening is crucial because it can both detect and prevent colorectal cancer by removing precancerous polyps before they develop into cancer, making it one of the most effective cancer prevention tools available. For those with a family history of colorectal cancer or advanced polyps, screening should start earlier, often at age 40 or 10 years before the youngest affected relative's diagnosis, as suggested by guidelines from the U.S. Multi-Society Task Force on Colorectal Cancer 1. It is essential to note that the quality of the colonoscopy is critical, and a high-quality colonoscopy can reduce the risk of colorectal cancer by 76%–90% 1.
• The quality of the colonoscopy can be evaluated by the adenoma detection rate, which should be measured by physicians performing screening colonoscopy 1.

From the FDA Drug Label

• The preferred method is the “Split-Dose” method and consists of two separate doses: the first dose during the evening before the colonoscopy and the second dose the next day, the morning of the day of the colonoscopy • The alternative method is the “Day Before” method and consists of two separate doses: the first dose during the afternoon or early evening before the colonoscopy and the second dose 6 hours later during the evening before the colonoscopy • Consume only clear fluids (no solid food) from the start of sodium picosulfate, magnesium oxide and anhydrous citric acid for oral solution treatment until after the colonoscopy. • Stop consumption of all fluids at least 2 hours before the colonoscopy.

The recommendations for a colonoscopy using sodium picosulfate, magnesium oxide, and anhydrous citric acid for oral solution are to follow either the Split-Dose or Day-Before method.

• Split-Dose method: Take the first dose in the evening before the colonoscopy and the second dose the next morning.
• Day-Before method: Take the first dose in the afternoon or early evening before the colonoscopy and the second dose 6 hours later. Key points:
• Consume only clear fluids from the start of treatment until after the colonoscopy.
• Stop consuming all fluids at least 2 hours before the colonoscopy. 2

From the Research

Recommendations for Colonoscopy

The following are recommendations for colonoscopy based on various studies:

• Average-risk individuals should undergo colonoscopy every 10 years, starting at age 50 3, 4, 5
• Individuals with a family history of colorectal cancer or advanced adenoma should undergo colonoscopy every 5 years, starting at age 40 or 10 years before the age of diagnosis of the youngest affected relative 3, 4, 6
• Individuals with a positive family history of colorectal cancer or advanced colorectal polyp should begin screening at age 40 4
• Individuals with ulcerative colitis or Crohn disease with colonic involvement should undergo colonoscopy every 1-3 years, starting 8-10 years after the onset of symptoms 6
• Individuals with hereditary nonpolyposis colorectal cancer should begin colonoscopy at age 25 and repeat every 1-2 years 6
• Individuals with adenomatous polyposis syndromes should begin screening at age 10 or in their mid-20s, depending on the syndrome, and repeat colonoscopy every 1-2 years 6
• Individuals with Peutz-Jeghers syndrome should begin screening at age 8 and repeat colonoscopy every 3 years if results are normal 6
• The optimal screening strategy for individuals with a family history of colorectal cancer varies depending on the number of affected first-degree relatives and their age at diagnosis, with shorter screening intervals recommended for higher-risk individuals 7

Screening Intervals

The recommended screening intervals for colonoscopy are:

• Every 10 years for average-risk individuals 3, 4, 5
• Every 5 years for individuals with a family history of colorectal cancer or advanced adenoma 3, 4, 6
• Every 1-3 years for individuals with ulcerative colitis or Crohn disease with colonic involvement 6
• Every 1-2 years for individuals with hereditary nonpolyposis colorectal cancer 6
• Every 1-2 years for individuals with adenomatous polyposis syndromes 6
• Every 3 years for individuals with Peutz-Jeghers syndrome if results are normal 6

Special Considerations

• Bowel preparation is crucial for accurate diagnosis and treatment of lesions found on colonoscopy 5
• The quality of bowel preparation can be improved by splitting the dose regimens 5
• A good endoscopic technique and optimal withdrawal time are essential for detecting lesions and optimizing the adenoma detection rate 5